The National Human Rights Commission on Tuesday sought a report from the Maharashtra government on the death of ten people in a fire at a hospital in Mumbai's Andheri, while not ruling out negligence by the hospital administration. The commission is exploring whether or not the hospital authorities were at fault and if the building was fire safety compliant. The answers to these questions, we may find out, are not singular to the ESIC Kamgar Hospital in Mumbai's Andheri area.

Even though a much detailed report on the exact cause of the fire, and whether or not it amounts to culpable negligence will be clarified later, the initial reports and firemen's accounts are all rife with telltale signs that authorities had little regard for safety arrangements.

The fire seems to have started because of a short circuit in the ground floor storage room where highly inflammable material, including rubber rolls, were kept. In the absence of proper vents, extinguishers and sprinkler mechanism, the blaze soon engulfed four of the ground-plus-five storeyed building in Andehri's Marol area. The resultant smoke then spread to the upper floors through an open fire duct and was the cause behind most casualties, a fireman told PTI.

The flames were so intense and the smoke so thick that firefighters reported difficulty in navigating through the structure. According to reports, their troubles were compounded by the glass facade of the building as it blocked air passage and firemen had to break the glasses on all the floors to evacuate those stranded inside.

"Most of the deceased, including the six-month-old child, died due to suffocation," the fire official said.

To add to this, the fire department revealed that the building had failed a safety audit just a fortnight before the tragedy struck.

Milind Ogle, the deputy chief fire officer of the MIDC area, said the hospital didn't have the final no-objection certificate for fire compliance. An under-construction new wing of the hospital had applied for NOC. But fire authorities not only found irregularities in the new building but even unearthed problems with the hospital’s old building, putting the latter’s NOC in the provisional category.

"When our team visited the hospital to inspect the conditions for fire compliance, it found certain shortcomings in the installations and it was communicated to the hospital administration," Ogle said. While reviewing fire compliance norms for the new building, the team also noticed some lacunae in the old hospital building, he said. "So we refused to issue the full and final fire NOC to the old building also," Ogle was quoted as saying.

The fact that the hospital authorities did little to rectify these shortcomings puts them in the grey even if the fire may have been caused by an unavoidable or unpredictable accident. The 325-bed hospital was constructed in the 1970s and has most likely been operating under stress with the sheer number of people it was handling than it was designed to admit.

However, that said, the Mumbai hospital fire isn't the only incident that validates this sorry reality.

Not a one-off incident

The National Disaster Management Authority put out safety guidelines for hospitals in February 2016, yet fires break out in private and government hospitals as well as in laboratories and wards. In October 2018, a short-circuit caused a fire in the ground floor pharmacy of the Calcutta Medical College in Wes Bengal. Though the authorities managed to evacuate over 200 people without any major casualty, deaths were averted not because the infrastructure had adequate fire-fighting systems but because of the presence of mind of hospital staff and patients' relatives and sheer good luck.

This time too, the fire compliance certificate had expired and because the medical supplies stored in the infirmary were highly combustible, the blaze quickly spread on to other floors. In the absence of stretchers and wheelchairs, relatives of panic-stricken patients, helped by hospital staff, carried them in their arms down the stairs, cradling saline bottles, a report in The Telegraphsaid.

The fire safety norms were ignored despite the fact that West Bengal had seen a horrible tragedy in private-run AMRI Hospitals, Dhakuria, nearly seven years ago where 90 people were killed. This is how a news report from the time details the horror: "Majority of the patients were in such a critical condition that they could not even move their limbs. They helplessly saw smoke enter their cabins as they suffocated to death. Those administered sedatives died in sleep."

Here too, the fire started with a small spark caused by a short circuit in the ageing electrical wiring system in the hospital's basement. It transformed into a blaze because a large number of flammable substances were kept in the basement of the building. The directors of the hospital were booked for culpable homicide not amounting to murder. The trial is still underway.

A major fire at the Institute of Medical Sciences and SUM Hospital in Bhubaneswar, Odisha, killed 22 people in October 2016. The subsequent reports on the incident revealed that the fire was caused by a short circuit and the fire safety norms as per the 2013 guidelines were not followed by the hospital authorities.

In January 2013, a fire caused by a faulty wiring system in Bikaner's PBM Hospital injured three infants and damaged property worth lakhs. The wires could not carry the load due to which the mishap occurred, the Outlookreported.

Short circuits, non-compliance to safety norms common cause of fires in hospitals

The common thread binding all the above examples, and many more cases, is that the fire often started with an electric short-circuit and was enraged by improper storage of highly inflammable medical supplies. In almost all the cases, non-compliance to safety norms was also found, indicating that not only the fire could have been avoided but losses could have been minimised had compliance to safety laws been up to the mark.

Dr RK Dave, former senior specialist on policy and plans, National Disaster Management Authority, pins this trend on the increasing load on the threadbare infrastructure of state-run as well as privately-owned hospitals. "At any given time, hospital gadgets consume five to ten times of the allowed electricity usage,” Dave told News18. He said that usually, these machines don’t function at the same time so no one suspects they can cause a problem. However, on the occasion they all are pressed into service at once, the wiring fails to take the load and a short circuit occurs.

"The electricity load on the day of commissioning a hospital almost doubles from the load estimated when the facility was designed," Dave explained.

He estimated that this load goes up nearly 25 percent annually. "The loads in city hospitals are increasing due to rapid urbanisation," Dave explained, adding, "and urban hospitals are no longer as resilient as they were five years ago."

Moreover, in event of a fire, what makes things worse is that many old hospitals do not have fire safety equipment like sprinklers. Even the roads inside big hospitals, which should be 6 metres wide according to the NDMA guidelines, are blocked with parked vehicles. If a fire breaks out, the fire tenders cannot even enter.

What makes a hospital fire worst is that the victims are often restricted in movement, thereby slowing down the evacuation process. The nature of medical equipment, supplies and machinery, is also more often than not combustible. This, in turn, makes training the staff to deal with such disasters extremely crucial.

An article in a healthcare journal states that if a small blaze broke out next to an MRI machine, firefighters wouldn't be able to use a traditional red metal extinguisher because powerful magnetism might yank it right out of their hands. Similarly, in many hospitals, more often than not the fire increases and smoke spreads because technicians unknowingly punch holes through firewalls to run new wires in hidden areas.

Thus, until hospital authorities are held accountable for ensuring regular inspections, and the medical staff is made to have compulsory training in handling natural disasters and accidents, our critical care units will continue to function on sheer luck, waiting for another such disaster to strike.